Insurance FAQs Health

General

Section 1312 of the Affordable Care Act requires that Members of Congress and designated congressional staff must obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange (Exchange). For more information, please contact your agency’s benefits officer. The Senate Benefits Section can be reached Monday – Friday from 9:00am – 5:30pm EST at (202) 224-1093. The House of Representatives Office of Payroll and Benefits can be reached Monday – Friday from 8:30am – 5:30pm EST at 202-225-1435. The House of Representatives Office of Members’ Services can be reached Monday – Friday from 8:30am – 5:30pm EST at (202) 225-3644.

Each year during the month of September, Members of Congress may submit a letter for the following calendar year to the administrative office denoting which employees of their staff are “official office” staff and/or not “official office” staff.

House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Small Business Health Options Program (SHOP). SHOPs were established to administer group health benefits to employees of small businesses. Given the location of Congress in Washington DC, OPM has determined that the DC SHOP, known as the DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and designated congressional staff will purchase health insurance in order to receive a government contribution. For more information, please visit OPM's webpage for Members of Congress.

Members of Congress will determine which of their staff members work in the official office. Members may delegate this responsibility to the House or Senate Administrative Offices. Those staff members that are designated as working in the official office must choose health plans from the DC Health Link.

The FEHB rule regarding reemployed annuitants and whether an OPM-contracted FEHB plan or Medicare pays first is that if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link), the FEHB plan will be first payor.
Though Members of Congress and designated staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.” The same FEHB rules for who is first payor in situations involving an OPM-contracted FEHB plan will apply for DC Health Link plans and the DC Health Link plan will pay first, before Medicare.
It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB eligibility (including DC Health Link). The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee. The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

Yes. As long as they meet other eligibility requirements, the former spouses of Members of Congress and designated congressional staff are eligible for Spouse Equity Act coverage. For more information about Spouse Equity Act, please see the OPM Former Spouse webpage and the Former Spouse section in the FEHB Handbook.

FEHB will be the primary payor. As stated in the Primary Payor Chart in Section 9, Coordinating Benefits with Medicare and Other Coverage, of the FEHB plan brochures, the rule regarding reemployed annuitants is that FEHB pays first if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link).
Though Members of Congress and designated congressional staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.” Therefore, the same FEHB rules for who is primary payor for other Federal reemployed annuitants apply to Members of Congress and designated congressional staff.
It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB (including DC Health Link) eligibility. The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee. The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

Affordable Care Act, Section 1312, defines congressional staff as all full-time and part-time employees employed by the official office of a Member of Congress. Therefore, staff who do not work for the official office of a Member will remain eligible for OPM-contracted FEHB plan coverage.

The purpose of the 31-day extension is to provide time for enrollees to select another health plan when their current OPM-contracted FEHB coverage is terminated. If you choose not to enroll in an employer-sponsored health benefits plan via the DC Health Link, an additional 31 days of coverage is included at no cost to you after the date that your OPM-contracted FEHB enrollment is terminated. If you DO choose to enroll in an employer-sponsored health benefits plan via the DC Health Link with a government contribution, your DC Health Link enrollment the 31-day extension of coverage will not apply.